1. Field of the Invention
The invention relates generally to an apparatus and method for performing a retropubic urethropexy procedure to correct female stress incontinence, and more specifically to a single needle assembly apparatus and method for manipulating a plurality of sutures, preferably suspending a surgical bolster, to facilitate the surgical procedure and improve morbidity.
2. Description of the Prior Art
Relaxation of muscles and tissues supporting the bladder neck can produce stress incontinence in the human female. Surgical correction of this condition can be effective when the bladder neck can be elevated and supported from above with heavy, non-absorbable sutures. Surgical procedures for this purpose have evolved from purely retropubic operations such as the Marshall-Marchetti procedure described in journal article "The Correction of Stress Incontinence by Simple Vesicourethral Suspension", Marshall, V. F., Marchetti, A. A., Krantz, K. E., Surgery Gynecology and Obstetrics, 88:590, 1949, and its variants such as described in the journal article "Urethrovaginal Fixation to Cooper's Ligament for Correction of Stress Incontinence, Cystocele, and Prolapse:, Burch, J. C., American Journal of Obstetrics and Gynecology, 81:281, 1961, to combined retropubic and vaginal operations. Such procedures are, for example, described in journal articles: "Combined Urethrovesical Suspension and Vaginourethroplasty for Correction of Urinary Stress Incontinence", Peyrera, A. J., and Lebherz, T. B., Obstetrics and Gynecology, 30:537, 1967; "Endoscopic Suspension of the Vesical Neck for Urinary Incontinence", Stamey, T. A., Surgery Gynecology and Obstetrics, 136:547, 1973; and "Modified Bladder Neck Suspension for Female Stress Incontinence", Raz, S., Suspension for Female Stress Incontinence", Raz, S., Urology, 17:82, 1981. This group of surgical operations, commonly and collectively referred to as needle suspensions, requires precise positioning of various needles for the placement of the heavy, non-absorbable sutures. Endoscopic confirmation of needle and suture placement has proven a valuable aspect of these operations.
However, technical difficulties with placement of the various needles in patients who have undergone prior incontinence surgery may result in repeated entries into the bladder, and/or less than optimal positioning of the sutures at other than the precise bladder neck. The relatively small cross-section of the sutures can produce physical stresses on the supported tissues that eventually cause the sutures to bear into the supported tissues, reversing the effect of the surgery.